BDental patients with severe periodontitis may have undiagnosed type 2 diabetes, Dutch researchers have discovered in a study that suggests targeted screening of individuals with worse gum disease could be a feasible way of picking up cases of diabetes at an early stage.
Using a highly accurate fingerstick test for HbA1c, researchers found that they could identify new cases of diabetes.
Their results in over 300 patients showed not only that HbA1c increased significantly with increasing severity of periodontitis, but that patients with severe periodontitis were twice as likely to have suspected diabetes than patients with milder gum disease or healthy controls.
The study, by lead author Wijnand J Teeuw, DDS, head of the periodontology clinic, Academic Center for Dentistry, University of Amsterdam, The Netherlands, and colleagues, was published online February 22 in BMJ Open Diabetes Research & Care.
The new research reinforces previous findings that periodontitis is linked to other serious conditions such as heart disease and myocardial infarction.
Furthermore, it builds on work suggesting that screening for diabetes at the dentist's office is feasible, thus offering greater opportunities to identify cases of undiagnosed diabetes, given that approximately 70% of Americans seek some kind of dental care at least once a year.
For example, a US study of over 400 patients indicated that oral blood collected during a routine dental procedure gives an HbA1c reading as accurate as traditional fingerstick readings.
The possibility for diabetes screening at the dentist was also bolstered by the recent development of a novel 14-item questionnaire designed specifically for use in the dentist's office to identify patients at high risk for medical conditions with oral involvement.
Study coauthor Susan Maples, DDS, from Holt, Michigan, previously told Medscape Medical News that she believes "dentists would be happy" to perform screening, "especially if they can negotiate with insurance companies about reimbursement."
One Step Further
As Dr Teeuw noted, "the dental clinic might be a suitable location" for screening, but there will be a "cost issue to screen everyone" so it would be better to be able to identify those at highest risk. "So, to make screening more effective, we were looking at oral complications of diabetes [in our study], and one of them turned out to be severe periodontitis."
"The first signs of periodontitis are often without any complications or pain, and due to the fact that diabetes patients, in the beginning, are very susceptible to infections and impaired wound healing, we thought that periodontitis might be one of the early signs of an underlying illness like diabetes," he explained.
So a screening program for diabetes targeted at individuals with severe periodontitis using an HbA1c fingerstick test would be easier to rollout, but cost may still be an issue.
One way around this would be simply for dentists to refer the patient to their primary care physician.
And if the fingerstick analysis is not available, "you at least think about an underlying pathology like diabetes and you refer your patient to the general practitioner for diagnosis." He added it is important to highlight that "as dentists, we are not equipped to do the diagnosis. We can only screen."